Provider Demographics
NPI:1942821681
Name:MISSION PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MISSION PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILTSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:315-783-6954
Mailing Address - Street 1:10205 US HWY 15-501 UNIT 26 #173
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4301
Mailing Address - Country:US
Mailing Address - Phone:315-783-6954
Mailing Address - Fax:
Practice Address - Street 1:155 ALLISON PAGE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315
Practice Address - Country:US
Practice Address - Phone:910-221-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy